Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 1;21(1):484.
doi: 10.1186/s12885-021-08208-6.

Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

Wei Li #  1 , Li Xiong #  1 , Qiaoling Zhu  1 , Hong Lu  2 , Meiling Zhong  3 , Meirong Liang  3 , Wei Jiang  3 , Yanan Wang  3 , Wei Cheng  4
Affiliations

Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

Wei Li et al. BMC Cancer. .

Abstract

Background: The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods.

Methods: Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed.

Results: The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5-1.0 cm were risk factors for CILN and/or PALN metastasis.

Conclusion: Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.

Keywords: Cervical neoplasm; Computed tomography (CT); Retroperitoneal lymph node; Squamous cell carcinoma antigen (SCC-Ag).

PubMed Disclaimer

Conflict of interest statement

The authors declare that they had no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study. CT, computed tomography; SCC-Ag, squamous cell carcinoma antigen; MAD minimum axial diameter; CILN, common iliac lymph node; PALN, para-aortic lymph node
Fig. 2
Fig. 2
Computed tomography (CT) scans and postoperative hematoxylin and eosin (H&E) staining of responding lymph node. a. Lymph node metastasis of adenocarcinoma (yellow arrow) comfirmed by H&E staining. b. Lymph node metastasis of adenosquamous carcinoma (yellow arrow) comfirmed by H&E staining. c. Lymph node metastasis of squamous cell carcinoma (yellow arrow) comfirmed by H&E staining. d. Normal lymph nodes. e. Measurement of MAD (≥ 1.0 cm) of the para-aortic lymph node. The yellow arrows showed the location of lymph node metastasis. The H&E staining result was positive. f. Measurement of MAD (0.5–0.9 cm) of the para-aortic lymph node. The yellow arrows showed the location of lymph node metastasis. The H&E staining result was negative
Fig. 3
Fig. 3
The critical values of computed tomography (CT) lymph node minimum axial diameter (MAD) (AUC = 0.782) and serum squamous cell carcinoma antigen (SCC-Ag) (AUC = 0.717) levels in evaluating retroperitoneal lymph node metastasis of cervical squamous cell carcinoma
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Wright JD, Matsuo K, Huang Y, Tergas AI, Hou JY, Khoury-Collado F, St Clair CM, Ananth CV, Neugut AI, Hershman DL. Prognostic performance of the 2018 International Federation of Gynecology and Obstetrics Cervical Cancer Staging Guidelines. Obstet Gynecol. 2019;134(1):49–57. doi: 10.1097/AOG.0000000000003311. - DOI - PMC - PubMed
    1. Heller PB, Malfetano JH, Bundy BN, Barnhill DR, Okagaki T. Clinical-pathologic study of stage IIB, III, and IVA carcinoma of the cervix: extended diagnostic evaluation for paraaortic node metastasis--a gynecologic oncology group study. Gynecol Oncol. 1990;38(3):425–430. doi: 10.1016/0090-8258(90)90085-Y. - DOI - PubMed
    1. Matsuo K, Shimada M, Saito T, Takehara K, Tokunaga H, Watanabe Y, Todo Y, Morishige KI, Mikami M, Sugiyama T. Risk stratification models for Para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer. J Gynecol Oncol. 2018;29(1):e11. doi: 10.3802/jgo.2018.29.e11. - DOI - PMC - PubMed
    1. Sakuragi N, Satoh C, Takeda N, Hareyama H, Takeda M, Yamamoto R, Fujimoto T, Oikawa M, Fujino T, Fujimoto S. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer. 1999;85(7):1547–1554. doi: 10.1002/(SICI)1097-0142(19990401)85:7<1547::AID-CNCR16>3.0.CO;2-2. - DOI - PubMed
    1. Huang L, Huang ZJ, Gao K. Advances in research on the treatment of cervical cancer with Para-aortic extension field radiotherapy. Chin J Obstet Gynecol. 2017;52(10):717–720.

MeSH terms

-